Montana 55 Winter 2019 by Missoulian

Winter 2019

Charting a new course Page 24

Travel hints Page 4

Downsizing Page 10

Page turner Page 22

the magazine for montanans in their prime

publisher jim strauss

editor emily petrovski sales coordinator jacque walawander

Montana 55 is a special publication of Lee Enterprises and the Missoulian. Copyright 2019. For advertising information contact Jacque Walawander 406-523-5271, or email jacque.walawander@lee.net www.mt55mag.com

Winter 2019

inside 4

travel dilemmas prepare for departure

Winter 2019

Social Security

Medicare expansion

words for older reader

life begins again

early warning signs

for her

help at home

local selections

staying relevant

back to work

time to downsize?

health savings accounts

keep moving

Alzheimerâ&#x20AC;&#x2122;s myths

hopping on the canna-bus

support circle

in a younger landscape

ďŹ nancial effects

senior housing

stealth retirement savings?

ďŹ&#x201A;exibility is key

next phase

dementia

helping the helpers

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Travel dilemmas:

The age of the tiger traveler By Catharine Hamm, Los Angeles Times (TNS) f you’re 55 or older, you should research your trip abroad before you go. Also, you should By Catharine Hamm, Los Angeles Times leave (TNS) copies of your itinerary, passport and contact information with a trusted person on the home front. About now, I picture you shaking your head and asking, “Of course I do these things. Do you think I am dumber than a bucket of hair?” I definitely do not. I’m not sure about the State Department, which included those suggestions on a “Checklist for Older Travelers.” If you are a baby boomer — born between 1946 and 1964 — this list is aimed at you. You plan to take as many as five leisure trips this year, and you’ll spend more than $6,000 on that travel. Almost half of you plan to travel domestically and internationally, and if you’re going abroad, you like the Caribbean, Latin American and Europe as destinations. That’s what AARP’s 2018 travel survey shows, results that are not much different from 2017, it notes. Older travelers are not novices. No rocking chair for these folks, unless they’re the ones you find in airports that are meant for de-stressing. If you can move beyond the State Department’s annoying initial underestimation of your experience, you’ll find that the list does contain substantive suggestions that are especially key for international travel. Some pertain to everyone, some only to older travelers, but all are important: Check your passport to be sure that it is valid for at least six months after your return. Countries are increasingly asking for that window on passports, and although your document is good for 10 years, the State Department has urged travelers to renew at the nine-year mark. If you are covered by Medicare at home, you probably aren’t covered overseas. You’ll want to buy a policy that includes health insurance and, for good measure, medical evacuation coverage, just to be safe. Make sure your prescriptions (which you know to carry in their original bottles and in your carry-on, not your suitcase) are legal in the country you’ll be visiting. While reporting a recent “On the Spot” column on this topic, I learned that some countries won’t allow some common meds such as Sudafed, so be wary of that too. There’s no central place to check what is and isn’t allowed, so if you’re uncertain, contact the embassy or consulate of the country you’ll be visiting. Under the helpful-but-not-complete category, State’s list also suggests finding out whether a place is accessible if you use assistive devices — cane, walker, wheelchair. Good idea, but how? Beth Godlin, president of Aon Affinity Travel Practice, a U.S.-based travel insurance and protection program, offered a solution instead of a suggestion. If you’re staying in a hotel, check with the concierge, Godlin said. If you’re on a group tour, your leader will know or can find out about accessibility. Having an expert with you is one of the benefits of group travel, but Godlin also reminds travelers of possible pitfalls: AssessWinter the 2019 level of activity required for a group trip. A tightly 4

packed schedule helps you see everything you want to see (and some stuff you don’t), but consider whether you need some downtime because, she said, people sometimes “underestimate the toll that foreign places will take on you,” especially, she noted, if you’re “relying on multiple forms of transportation.” Ah, yes, that plane trip is one of those forms, and it often begins your adventure. A trip, like life itself, can feel like an endurance contest, especially if your journey starts with a long flight. Be aware that: You may feel groggy after hours in the air, and for this you can blame your aircraft. Many are pressurized to 8,000 feet so you may experience a bit of oxygen deprivation, said Dr. Nikhil K. Bhayani, an infectious disease specialist at Texas Health HEB. But don’t assume you’ll be like the walking dead, because if you’re generally healthy “your body will compensate,” he said. Even someone with a heart condition should be OK if “you’re stable and you’re on medication,” he said. No matter what your age, you cannot sit like a lump in your seat for the entire flight. You need to get up and move, Bhayani said, to avoid blood clots. Long trips often mean jet lag, which can throw you off your game, so it’s imperative that you stay clear-headed to keep track of your meds. You’ll find numerous apps that can help, but here’s the analog solution: Download the American Heart Association/American Stroke Association “Medicine Chart” (lat.ms/medicinechart), which, if filled in properly, will become a trove of information with your pharmacy phone number, refill date, how often you take the medication and times to take it and what it looks like. You can print this out and, just in case, email it to yourself. Stay hydrated and avoid alcohol. That’s true wherever you are and whatever your age, perhaps more so on a plane where the air is dry. If the thin cabin air makes you feel dopey, you may be doubly dopey if you fail to drink. As one of my friends constantly reminds me, “Hydrate to be great,” though I’d settle for better than average. Take some liquid lemon with you, he said. Huh? Dehydration can cause bad breath, and he finds that lemon or lime juice, perhaps mixed with water, can cleanse the palate. Plus it will make you a better seatmate. Finally, here’s another nasty little side effect of flying, besides bloating and gassiness, Bhayani said: constipation. Our routines are altered, and we may tend to avoid those Tom Thumb-size aircraft bathrooms. Our bodies get confused and they rebel. Check with your doc for a remedy (besides not altering your routine and staying hydrated), which might include over-thecounter meds. That State Department list is really a starting point, sort of like the advice your Aunt Agnes used to give you that you’d always appear to be taking in even if you already knew it. A reminder never hurts — quickly, off the top of your head, when does your passport expire? — but those who are 55? I crown them tiger travelers. They have the right combination of age, experience and openness to keep on growing no matter where they’re going. MT55

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By Sharon Jayson

Will we still be relevant ‘when we’re 64’?

gnawing sense of irrelevancy and invisibility suddenly hits many aging adults, as their life roles shift from hands-on parent to empty nester or from workaholic to retiree. Self-worth and identity may suffer as that feeling that you matter starts to fade. Older adults see it in the workplace when younger colleagues seem uninterested in their feedback. Those who just retired might feel a bit unproductive. New research suggests this perception of becoming irrelevant is very real. And that’s why some seniors are determined to stay social, remain relevant and avert the loneliness often linked with aging. “As people get older, there are fewer and fewer opportunities to feel like they make a difference and matter,” said sociologist Markus Schafer, a faculty associate at the Institute for Life Course and Aging at the University of Toronto. “One thing about Western societies, in general, is they’re much more a youth-centered society and don’t often times

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give careful thought on ways older people can contribute to the lives of future generations,” Schafer said. When people reach their 60s, opportunities to offer advice drop dramatically, said Schafer, the lead author of a study on how offering advice gives life more meaning. Overall, 1 in 5 adults in their 60s said they did not give advice to anyone in the past year, and the rate dropped to 1 in 4 people 70 and older, according to a 2016 study of more than 2,500 adults published in Social Psychology Quarterly. That’s not all. A national survey of 1,000 adults age 64 and older conducted in August by the California-based nonprofit SCAN found almost one-quarter of respondents agree “they aren’t important to anyone anymore.” Having purpose and meaning forestalls loneliness, which takes an emotional and physical toll. Studies by Lisa Jaremka and other researchers have found that loneliness is associated with weaker immune systems and poorer physical health. In one study published in 2013, Jaremka, an assistant pro-

fessor of psychological and brain sciences at the University of Delaware in Newark, found that lonely people had more inflammation than those who felt more socially connected. Chronic inflammation is linked to various diseases, as well as functional decline and frailty. “Maintaining that social engagement can give you a greater sense of purpose and give a sense of motivation that can make you behave in ways that are better for your health,” said sociologist Patricia Thomas, a faculty associate in the Center on Aging and the Life Course at Purdue University in West Lafayette, Ind., who studies social engagement among older adults. Some older adults in Austin, Texas, are finding their purpose with a community created by Aging is Cool, an active-aging company founded just over a year ago. “It’s about staying visible and staying engaged,” cofounder Amy Temperley said. “If you hunker down in your house and you don’t interact with the world, you will decline.” The model she and her husband, Damien, devised offers options to keep individuals active and engaged. For $24 a month, members can attend unlimited classes and group activities, including brain and memory training; social and volunteer activities and fitness classes that stress strength, mobility and flexibility. Rosie Cortez, 66, a grandmother of two, got involved after a heart attack spurred her to lose weight and exercise more. She also needed more stimulating company. “At one time, I did spend a lot of time with my grandkids and I loved it — but you also need adult time,” Cortez said. “We really wanted people to have a sense of community,” Amy Temperley said. “Now they’re starting to talk about themselves as a tribe. They get together after classes. It’s evolved into not what we expected but better than we expected.” In addition to the membership group, the company offers 40-50 classes a month at assisted living and senior living communities. It also maintains a nonprofit fund at a local community foundation, allowing it to raise money for free classes at senior housing and recreation centers in low-income neighborhoods to spur social connections. Similar efforts are underway across the country as organizations from the National Council on Aging to local YMCAs as well as city parks and recreation centers create social and recreational programs for “active older adults.” A program to boost well-being, strength and social activities called SilverSneakers, for adults 65 and older, is free with certain health plans. Although approaches vary, the overall aim for active older adults is to promote physical and mental agility and keep loneliness at bay. Among these strategies, volunteering is now seen as an effective way to battle irrelevancy and loneliness. Buoyed by research that’s found health benefits for older adults who volunteer, one such study led by a Florida State University sociologist showed that volunteering appeared to have the same positive influence on health as exercise and not smoking.

“Volunteering is shown to be, in many ways, a health behavior,” said Dawn Carr, an assistant professor of sociology at Florida State in Tallahassee. Her study, published last year in the Journals of Gerontology: Social Sciences, found that “becoming actively engaged in volunteering in later life is related to lower levels of subsequent disability.” Retired school nurse Linda Levy, 69, has always been an active volunteer, even as a mother working full time in Pikesville, Md. But after she and her husband moved to Austin about 18 months ago to be closer to their son’s family, Levy is doing something new — working part time in retail.

“I just wanted to do something I could fit in with my schedule for family and to meet people,” she said. “It gave me a purpose. I needed to be able to say ‘I’m going to work.’” Finding employment isn’t so easy for older adults, which is why job search strategist Toby Haberkorn co-wrote a book, out last year, titled “Best Job Search Tips for Age 60-Plus: A Practical Work Options Resource for Baby Boomers.” Haberkorn advises job seekers to update their appearance and “show you have the energy and expertise to manage the workload.” Haberkorn’s tips to stay relevant in the workplace are also pertinent in daily life: “Show flexibility and adaptability rather than regurgitating the past. Become reasonably social media- and technology-savvy. Familiarize yourself with what young employees have an interest in — the music, whatever current events, the apps — and be able to have a reasonable discussion. Do not say ‘Boomers have a better work ethic.’ Never, ever say ‘I’m having a senior moment’ or ‘I have a child your age.’ Don’t discuss your grandchildren. And keep your aches to yourself.” Haberkorn also advises taking a hint from 96-year-old actress Betty White. “She still produces good work and she has a great amount of energy,” Haberkorn said. “Her entire package promotes a youthful and optimistic attitude.” MT55

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Heading back to work

etirement is a great opportunity to travel, learn, read, rest and spend time with your family. The last thing you want to think about is going back to work. However, many retirees find themselves heading back into the workforce out of a desire for more career challenges, a way to fill time or a need for money or health insurance in retirement. As you’re thinking about returning to the workforce for full- or part-time work, consider several questions. Health insurance may be a big factor, according to New Retirement. People who retire before age 65, when Medicare kicks in for all Americans, may find insurance and other out-of-pocket costs eating into 8

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their retirement savings, so getting a job that provides health insurance can be the most financially sound option. There are some part-time jobs that offer health insurance, so consider those options as you’re looking at a return to the workforce. Other people find they have not saved enough money for retirement and need the salary. Determine how much additional money you need each month to determine if you need full- or part-time work. It’s also a good idea to talk to your financial planner to see if you’ll face any tax implications. In addition to your planner, talk to the Social Security Administration in your area. According to New

Retirement, Social Security income could be reduced if you go back to work, depending on what age you were when you retired. Full retirement age is 67 for people born 1960 or later, and if you retire before 67, you will receive less money from Social Security each month. If you retire and go to back to work before you reach 67 (or the full retirement age, which may be younger for those born before 1960), Social Security deducts a dollar in benefits for every $2 you earn above the annual limit, though this is not a permanent change. Finally, if you have a pension, it could be affected if you go back to work for the same company or organization that you worked during your career. Often, companies will suspend benefits when you get back on their payroll, so check with the company so you donâ&#x20AC;&#x2122;t get an unpleasant surprise your first month. Your pension shouldnâ&#x20AC;&#x2122;t be unaffected if you work somewhere new. MT55

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Winter 2019

Upkeep or downsize?

etirement opens up a range of options for housing. Some people choose to stay in the homes in which they raised their families, keeping space for visiting family, enjoying a big backyard and staying close to their pre-retirement lifestyle. Others sell their house and move somewhere smaller, possibly even a condo or townhouse, reducing the need for yardwork, or they choose to relocate somewhere else — closer to family or to a more temperate climate. At some point, people may opt for a senior living community. The decision is different for each retiring person or couple depending on their wants, needs and financial situations. Forbes suggested making the decision with two factors in mind: quality of life and financial reasons. Although more than 80 percent of Americans say they would prefer to stay in their homes through retirement, it may not be the best choice long-term. Financial questions Can you afford to keep your home? That includes a mortgage payment, insurance and upkeep. Even if you can make those payments, leveraging the equity in your home for a less expensive housing option may allow you more financial freedom in retirement. According to a 2015 Merrill Lynch

study, most Americans of retirement age have more than $200,000 in equity in their homes but less than half of that in retirement savings. Can you afford to move? A smaller home doesn’t always lower your expenses — you may want to live somewhere with a higher cost of living, or you look at a smaller but nicer home or an area with more amenities. Consider the differences you’ll see in finances. Additionally, moving itself is expensive. Quality of life considerations Many people want to travel when they retire or otherwise have more freedom. If this is you, selling your house and renting a home or apartment may allow for that lifestyle. Even if you don’t plan to roam, you may want less responsibility for maintenance and upkeep, which can be achieved either through renting or buying a property in a neighborhood with an involved homeowners association. Also consider whether you want to stay. Perhaps your friends and family are all in this community, you’ve joined organizations and have roots that you want to keep. Or you may find yourself in a school district with high property taxes that made sense when kids were in school but no longer do now that you’re empty nesters. MT55

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Health savings account:

Stealth savings vehicle By Erin Arvedlund, The Philadelphia Inquirer (TNS)

e’ve been hearing a lot about health savings accounts –– a sort of stealth retirement savings vehicle from which investors can withdraw money tax-free for medical expenses. HSAs are worth a look, although they’re not for everyone. If you’re covered by a qualified

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high-deductible health plan, you can contribute pre-tax income to an employer-sponsored health savings account or make deductible contributions to an HSA you set up through a brokerage firm. Qualified plans have an annual deductible of at least $1,350 for an individual or $2,700 for a family, according to Healthcare.gov.

A health savings account is an investment account, which can bear interest or be invested in the markets, similar to an IRA. Here’s the upside: Withdrawals for qualified medical expenses are taxfree, and you can carry over a balance from year to year. The IRS in March 2018 issued guid-

ance for 2018 HSA contributions of $3,450 for individuals and $6,900 for those with family coverage ($7,900 for HSA owners age 55 or older), according to the Isdaner & Co. accounting firm in Bala Cynwyd, Pa. One drawback: If you’re enrolled in Medicare, you can’t contribute to an HSA. However, you can create one before you enroll in Medicare and still take tax-free money out for qualified medical expenses. IRA adviser and tax expert Sarah Brenner created a helpful list of all the things you can pay for using money withdrawn tax-free from your HSA: •

•

Qualified medical expenses, including doctor and hospital bills, medical supplies, prescriptions, copayments, dental care, vision services and chiropractic expenses. Your spouse or child’s medical expenses, even if they are not covered by your high-deductible health-insurance plan. Even after your death, your spouse can use the money tax-free for qualified expenses. Medical expenses in a previous year, as long as expenses were incurred after you established your HSA. That means you do not have to withdraw money from an HSA every time you have a medical expense. You

•

can pay out of pocket, and let your account grow, or reimburse yourself in a later tax year Qualified medical expenses incurred even after you no longer have a high-deductible health plan and no longer contribute to your HSA. Certain Medicare insurance premiums after you turn 65, but not Medigap premiums.

Not everyone is a fan of HSAs, including investor Lisa Hastings. “I personally think HSAs are not worth the bother unless someone is so healthy and has so much extra money that all they really need is catastrophic health insurance,” she said. “People who hawk these often forget to say that HSA plans only come with very high-deductible health insurance. They are fine for young people without health issues, but for people who actually go to the doctor or have regular medications, they are a waste of money,” she said. “The idea (of HSAs) is that you don’t pay for insurance you don’t need and can save the rest tax-free, but I’d rather pay less for my health costs now and put the money from a lower deductible and health expenses into an investment account.” MT55

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If you can’t do these movements, you’re in trouble By Wina Sturgeon, Adventure Sports Weekly (TNS)

s humans grow older, their lives usually get less physical. Those 55 and older do a lot more sitting. They are much less active. The problem with this is that important ranges of motion can be lost, the joints and muscles atrophied by lack of use. Bodies become stiff. The stiffness makes it harder, even more painful, to do the same simple movements that were done without even thinking about them years ago. This is much more serious than merely being out of shape. Someone once said, “Age reels you in.” This is an apt description of what happens over the years if you allow it to happen. Do you wonder if your own ability to move is older than you are? Three simple movements will answer that question for you. The first is, as mentioned, a simple move. It consists of sitting down on the floor. Don’t lean against anything. Don’t have anyone lower you down. Just get into a sitting position on the floor without any help. Once seated, draw your legs up or stretch them out straight in front of you, whichever is most comfortable. Keep your back straight. The second movement is just as simple; it’s even easier, actually. Stand up. Simply stand up, without anyone

grabbing your hand to pull you up, or using any object other than the floor to get upright again. It’s something you do many times a day from a chair, couch or another seat. The third part of this test is also a simple move: While sitting in a chair, or on a couch, put your head on or between your knees. It’s the classic position for someone who is feeling faint or dizzy and has nowhere to stretch out and lay down. Can you do all three? If not, that shows that you have lost a lot of your flexibility and range of motion. In fact, you were probably surprised to learn that you can no longer get your body to do these movements. They were always easy when you were younger. However, with a little practice, you will be able to do the ‘Three position challenge.’ The range of motion you will regain more than makes up for the efforts you will have to make to accomplish this task. No one would ever choose to be ‘fragile’ in their 70’s or 80’s, and these exercises will help you avoid that fate. Here are the reasons why it’s important to be able to do these three movements: The sit-down-on-the-floor move uses nearly every muscle and joint in your lower body, and several muscles in your torso. The stand-upagain move not only tests but im-

proves your agility and coordination. If you are unable to put your head on or between your knees, that shows that your lack of activity has caused your spine to contract. The shrinking of the spine is one of the major reasons we get shorter as we age. Here are tips to help you do these three movements: For sitting down, go to a kneeling position, turn onto one hip and one elbow, turn your knees up and push yourself into a sitting position with your back straight and your legs in a comfortable position. For standing up, lean sideways onto one hip and one elbow, draw your legs into a kneeling position again and stand up. Some folks who haven’t made moves of this sort in many years may get leg cramps while practicing. The mineral supplement potassium gluconate can help stop leg cramps. When doing the spinal stretch of bending your head to your knees, be very gentle and stop at the slightest sign of pressure or pain in your backbone. Easy does it with this movement. MT55 Wina Sturgeon is an active 55+ based in Salt Lake City, who offers news on the science of anti-aging and staying youthful at: adventuresportsweekly. com. She skates, bikes and lifts weights to stay in shape.

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Day-tripping to the dispensary Seniors in pain hop aboard the canna-Bus

Stephanie O’Neill, Kaiser Health News

hirley Avedon, 90,had never been a cannabis user. But carpal tunnel syndrome that sends shooting pains into both of her hands and an aversion to conventional steroid and surgical treatments is prompting her to consider some new options. “It’s very painful, sometimes I can’t even open my hand,” Avedon said. So for the second time in two months, she’s climbed on board a bus that provides seniors at the Laguna Woods Village retirement community in Orange County, Calif., with a free shuttle to a nearby marijuana dispensary. The retired manager of an oncology office says she’s seeking the same relief she saw cancer patients get from smoking marijuana 25 years ago. “At that time [marijuana] wasn’t legal, so they used to get it off their children,” she said with a laugh. “It was fantastic what it did for them.”

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Avedon, who doesn’t want to get high from anything she uses, picked up a topical cream on her first trip that was sold as a pain reliever. It contained cannabidiol, or CBD, but was formulated without THC, or tetrahydrocannabinol, marijuana’s psychoactive ingredient. “It helped a little,” she said. “Now I’m going back for the second time hoping they have something better.” As more states legalize marijuana for medical or recreational use — 33 states plus the District of Columbia to date — the cannabis industry is booming. Among the fastest growing group of users: people over 50, with especially steep increases among those 65 and older. And some dispensaries are tailoring their pitches to seniors like Avedon who are seeking alternative treatments for their aches, pains and other medical conditions. On this particular morning, about 35 seniors climb on board the free shuttle — paid for by Bud and Bloom, a

licensed cannabis dispensary in Santa Ana. After about a half-hour drive, the large white bus pulls up to the parking lot of the dispensary. About half of the seniors on board today are repeat customers; the other half are cannabis newbies who’ve never tried it before, said Kandice Hawes, director of community outreach for Bud and Bloom. “Not everybody is coming to be a customer,” Hawes said. “A lot are just coming to be educated.” Among them, Layla Sabet, 72, a first-timer seeking relief from back pain that keeps her awake at night, she said. “I’m taking so much medication to sleep and still I can’t sleep,” she said. “So I’m trying it for the back pain and the sleep.” Hawes invited the seniors into a large room with chairs and a table set up with free sandwiches and drinks. As they ate, she gave a presentation focused on the potential benefits of cannabis as a reliever of anxiety, insomnia and chronic pain and the various ways people can consume it. Several vendors on site took turns speaking to the group about the goods they sell. Then, the seniors entered the dispensary for the chance to buy everything from old-school rolled joints and high-tech vaporizer pens to liquid sublingual tinctures, topical creams and an assortment of sweet, cannabis-infused edibles. Jim Lebowitz, 75, is a return customer who suffers pain from back surgery two years ago. He prefers to eat his cannabis, he said. “I got chocolate and I got gummies,” he told a visitor. “Never had the chocolate before, but I’ve had the gummies and they worked pretty good.” “Gummies” are cannabis-infused chewy candies. His

contain both the CBD and THC, two active ingredients in marijuana. Derek Tauchman rings up sales at one of several Bud and Bloom registers in the dispensary. Fear of getting high is the biggest concern expressed by senior consumers, who make up the bulk of the dispensary’s new business, he said. “What they don’t realize is there’s so many different ways to medicate now that you don’t have to actually get high to relieve all your aches and pains,” he said. But despite such enthusiasm, marijuana isn’t well researched, said Dr. David Reuben, the Archstone Foundation professor of medicine and geriatrics at UCLA’s David Geffen School of Medicine. While cannabis is legal both medically and recreationally in California, it remains a Schedule 1 substance — meaning it’s illegal under federal law. And that makes it harder to study. The limited research that exists suggests that marijuana may be helpful in treating pain and nausea, according to a research overview published last year by the National Academies of Sciences, Engineering and Medicine. Less conclusive research points to it helping with sleep problems and anxiety. Reuben said he sees a growing number of patients interested in using it for things like anxiety, chronic pain and depression. “I am, in general, fairly supportive of this because these are conditions [for which] there aren’t good alternatives,” he said. But Reuben cautions his patients that products bought at marijuana dispensaries aren’t FDA-regulated, as a prescription drugs are. That means dose and consistency can vary.

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“There’s still so much left to learn about how to package, how to ensure quality and standards,” he said. “So the question is how to make sure the people are getting high-quality product and then testing its effectiveness.” And there are risks associated with cannabis use too, said Dr. Elinore McCance-Katz, who directs the Substance Abuse and Mental Health Services Administration. “When you have an industry that does nothing but blanket our society with messages about the medicinal value of marijuana, people get the idea this is a safe substance to use. And that’s not true,” she said. Side effects can include increased heart rate, nausea and vomiting, and with long-term use, there’s a potential for addiction, some studies say. Research suggests that between 9 and 30 percent of those who use marijuana may develop some degree of marijuana use disorder. Still, Reuben said, if it gets patients off more addictive and potentially dangerous prescription drugs — like opioids — all the better. Jim Levy, 71, suffers a pinched nerve that shoots pain down both his legs. He uses a topical cream and ingests cannabis gelatin capsules and lozenges. “I have no way to measure, but I’d say it gets rid of 90 percent of the pain,” said Levy, who — like other seniors here — pays for these products 18

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out-of-pocket, as Medicare doesn’t cover cannabis. “I got something they say is wonderful and I hope it works,” said Shirley Avedon. “It’s a cream.” The price tag: $90. Avedon said if it helps ease the carpal tunnel pain she suffers, it’ll be worth it. “It’s better than having surgery,” she said. Precautions to keep in mind Though marijuana use remains illegal under federal law, it’s legal in some form in 33 states and the District of Columbia. And a growing number of Americans are considering trying it for health reasons. For people who are, doctors advise the following cautions. Talk to your doctor. Tell your doctor you’re thinking about trying medical marijuana. Although he or she may have some concerns, most doctors won’t judge you for seeking out alternative treatments. Make sure your prescriber is aware of all the medications you take. Marijuana might have dangerous interactions with prescription medications, particularly medicines that can be sedating, said Dr. Benjamin Han, a geriatrician at New York University School of Medicine who studies marijuana use in the elderly. Watch out for dosing. Older adults metabolize drugs differently than young people. If your doctor gives you

the go-ahead, try the lowest possible dose first to avoid feeling intoxicated. And be especially careful with edibles. They can have very concentrated doses that don’t take effect right away. Elderly people are also more sensitive to side effects. If you start to feel unwell, talk to your doctor right away. “When you’re older, you’re more vulnerable to the side effects of everything,” Han said. “I’m cautious about everything.” Look for licensed providers. In some states like California, licensed dispensaries must test for contaminants. Be especially careful with marijuana bought illegally. “If you’re just buying marijuana down the street … you don’t really know what’s in that,” said Dr. Joshua Briscoe, a palliative care doctor at Duke University School of Medicine who has studied the use of marijuana for pain and nausea in older patients. “Buyer, beware.” Bottom line: The research on medical marijuana is limited. There’s even less we know about marijuana use in older people. Proceed with caution. Jenny Gold and Mara Gordon contributed to this report. This story is part of a partnership that includes NPR and Kaiser Health News. MT55 KHN’s coverage of these topics is supported by John A. Hartford Foundation and The SCAN Foundation

Why Social Security is especially important to older women By Nicole Tiggemann, Tribune News Service (TNS)

ocial Security plays an especially important role in providing economic security for women. In the 21st century, more women work, pay Social Security taxes and earn credit toward monthly retirement income than at any other time in our nation’s history. But, women face greater economic challenges in retirement. Women: • Tend to live longer than men. A woman who is 65 years old today can expect to live, on average, until about 87, while a 65-year-old man can expect to live, on average, until about 84; • Often have lower lifetime earnings than men; and • May reach retirement with smaller pensions and other assets than men. Social Security offers a basic level of protection to all women. When you

work, you pay taxes into the Social Security system, providing for your own benefits. In addition, your spouse’s earnings can give you Social Security coverage as well. Women who don’t work are often covered through their spouses’ work. When their spouses retire, become disabled, or die, women can receive benefits. If you’re a worker age 18 or older, you can get a Social Security Statement online. Your Statement is a valuable tool to help you plan a secure financial future, and we recommend that you look at it each year. Your Statement provides a record of your earnings. To create an account online and review your statement, visit our website at www.socialsecurity.gov/myaccount. If your spouse dies, you can get widow’s benefits if you’re age 60 or

older. If you have a disability, you can get widow’s benefits as early as age 50. Your benefit amount will depend on your age and on the amount your deceased spouse was entitled to at the time of death. If your spouse was receiving reduced benefits, your survivor benefit will be based on that amount. You may be eligible for widow’s benefits and Medicare before age 65 if you have a disability and are entitled to benefits. You also may be eligible for benefits if you are caring for a child who is younger than 16. Our “People Like Me” website for women has valuable resources for people of all ages. You can access it at www.socialsecurity.gov/people/ women. MT55

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Medicare expands access to in-home support services, extra benefits RICARDO ALONSO-ZALDIVAR Associated Press WASHINGTON — Medicare is experimenting with a new direction in health care. Starting this year, seniors in many states will be able to get additional services such as help with chores and respite for caregivers through private Medicare Advantage insurance plans. There’s a growing recognition that such practical help can have a meaningful impact on patients’ well-being — and reduce some costs for taxpayers. A couple of hundred dollars to install grab bars in the shower can prevent a fall leading to a broken hip, a life-changing injury. That may also help elderly people stay in their homes longer. 20

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The newly covered services are similar to what people might need if they required long-term care, said Howard Gleckman, a senior researcher at the nonpartisan Urban Institute think tank. “It begins to break down the wall between long-term care and Medicare, which, with very few exceptions, has never paid for long-term care,” Gleckman said. Change is starting slowly. Policymakers have yet to figure out how to bring similar benefits to traditional Medicare, still the choice of two out of three seniors. The new services will be offered by some Medicare Advantage plans

in more than 20 states next year, and that’s expected to grow over time. There has to be a health-related reason to qualify, and costs will vary among plans. In some plans, there’s no added cost. But limits do apply. For example, a plan may cover one day per week at an adult day care center. Nearly 23 million Medicare beneficiaries, or more than one in three, are expected to be covered by a Medicare Advantage plan next year. The private plans generally offer lower out-ofpocket costs in exchange for limits on choice of doctors and hospitals and other restrictions such as prior authorization for services. It’s a growing business for insurers.

For years, Medicare has permitted private plans to offer supplemental benefits not covered by the traditional program. Think free gym memberships, transportation to medical appointments or home-delivered meals following a hospitalization. The new benefits take that to a higher level, with Medicare’s blessing. “It is a big concept, in the sense that it is officially encouraging plans to get across the line into the many, many things that affect the health and well-being of beneficiaries,” said Marc Russo, president of insurer Anthem’s Medicare business. “I, for one, who have been in and around Medicare for decades, believe it pays.” Insurers under Anthem’s corporate umbrella are offering different packages in 12 of 21 states where they operate Medicare plans. They can include alternative medicine, like acupuncture, or adult day care center visits or a personal helper at home. Other major insurers like United-

Healthcare and Humana are participating. It’s a calculated gamble for insurers, who still have to make a profit. And the limited new benefits are no substitute for full long-term care coverage, which many people need for at least part of their lives and remains prohibitively expensive. Seniors trying to get long-term care through Medicaid, the program for low-income people, must spend down their life savings. “Medicare policy has not kept up with the times,” said Sen. Ron Wyden, D-Ore., one of the authors of bipartisan legislation seen as a catalyst for expanded services through Medicare Advantage. Wyden said he’s working to bring similar options to traditional Medicare. “Clearly this is going to have to be an effort that is going to have to be built out,” he added. The changes represent a rare consensus at a time when health care issues are among the most politically

divisive. Republican and Democratic lawmakers, as well as Seema Verma, the Trump administration’s Medicare chief, are pulling in the same direction. The idea of broader services through Medicare Advantage was embodied in a bipartisan Senate Finance Committee bill to improve care for chronically ill seniors. The Trump administration issued regulations in the spring trying to accelerate the changes. According to Medicare, 12 insurers will be offering expanded supplemental benefits this year through 160 plans in 20 states. In four other states and Puerto Rico, such benefits may be available to seniors with certain health conditions. “The guidance came out fairly late in the annual planning process, and that’s one reason why some of these benefits may start out small,” said Steve Warner, head of Medicare Advantage program development for UnitedHealthcare. MT55

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Words for the older reader Rachel Crisp-Phillips Montana 55 eading — one of the greatest small joys of life — can become increasingly difficult as one becomes older and senses and sensibilities begin to wane. Fortunately, there are many resources and technological advances readily available for any aging bibliophile.

BENEFITS COME TO MIND Aside from the innate pleasure in popping open a good book, there are numerous benefits to pursuing the printed page long after your so-called prime. Best of all, it’s never too late to start, as participating in brain-stimulating activities can reap rewards at any age. 22

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The intellectual act of reading does wonders for the mind and can delay the onset of dementia, Alzheimer’s, and other illnesses that diminish memory and thinking skills. Daily activities that stimulate the brain, such as reading and playing games, have been shown to boost cognitive function in numerous scientific studies, even when considered independently from other age-defying activities such as healthy eating and regular exercise. THE EYES ARE THE WINDOWS Regular eye exams are the best foundation for fair sight far into old age. But when vision begins to wane, and small print seems to be Cyrillic, the first line of defense is to seek the insight of an eye doctor. When vision correction is required,

there are a number of options ranging from a simple pair of glasses to surgical intervention involving lasers. Only your doctor can prescribe what’s right for you, but it’s imperative to correct any physical detriments before they become a bane. In addition to providing assistance for reading and other intellectual activities, proper vision is crucial for maintaining overall physical health. Poor vision can contribute to anxiety, depression, fatigue, headaches, loss of concentration, and more. LIBRARY RESOURCES After treating any vision issues, it’s time to dive in to the depths of reading. Local libraries continue to be an excellent resource for readers of all ages and interests. Along with the typi-

cal bound books, libraries are home to an ever-increasing number of physical and digital alternatives. Libraries of most any size will have a section exclusively for large-print editions, which are much easier on the eyes than a typical typeset edition. These books are a boon to any voracious reader; even those with good eyesight will find relief from strain that results in a more enjoyable reading experience. On the digital side, MontanaLibrary2Go is an online collection of free eBooks for Kindle devices or reading apps. It’s available in conjunction with most Montana library memberships and allows users to browse, borrow and enjoy eBooks and audiobooks statewide. Check with you local library or visit https://montana. overdrive.com for details on how to sign up. At the ultra-local level, look for little free libraries in your neighborhood to find fun reads and to participate in an act of human kindness. These nifty nooks can pop up almost anywhere and offer books to passersby on a “take a book, return a book” honor system. To locate a little library near you, or to find information on building your own, visit https://littlefreelibrary.org/. TURN TO TECHNOLOGY While a majority of computer displays still use LCD screens, an increasing number of portable devices are taking advantage of e-Ink displays. This technology mimics the appearance of ink on paper, without glare or excessive lighting. Because of this, e-Ink can be a bit easier on the eyes and result in less eye strain than what is typically caused by prolonged screen staring. However, frequent breaks should always be taken from any electronic display. As an added benefit, an electronic reading device is often easier to hold and weighs less than a typical novel. This can reduce strain in aching hands

and fingers, as well as being easier to transport. Hundreds of books can be right at hand in a purse or pocket, making it convenient to read on a whim. Audiobooks are another innovation that assist in checking off that booksto-read list, and their accessibility can’t be beat. Catch up on any number of titles while washing the dishes, driving a car, or doing nothing else at all. TIME TO SOCIALIZE Adding a bit of socialization into your reading routine can help keep your brain keen. Consider joining a book club or attending local book readings to get acquainted with likeminded folks and jump-start your

noggin with some stimulating conversation. Additionally, the simple act of reading children’s books to grandchildren or at a local children’s library can be advantageous to both parties as the large print and simple words are easy for all to enjoy. And, of course, the opportunity for bonding time is invaluable. THINK LOCAL Once you’re ready to read, consider filling your personal library with works

by local Montana talent. The Big Sky State is a big draw for those who work with words. This short, and certainly incomplete, list provides a prime start to reading up on Montana authors. History buffs may be pleased to peruse Knapsacks and Roses, Montana’s Women Veterans of World War I, a recent release by Edward E. Saunders. Rick Bass, author of Why I Came West, is a writer and environmental activist who protects, and frequently muses upon, the mystical Yaak Valley in northwest Montana. For poetry fans, look into the works of Lowell Jaeger, the current Montana State Poet Laureate. Previous Poet Laureates for the state of Montana include Sandra Alcosser, Greg Pape, Henry Real Bird, Sheryl Noethe, Tami

Haaland, and Michael Earl Craig. For something a bit different, The Bluebird Run, by Greg Keeler is a clever collection of 180 sonnets. A. B. Guthrie Jr.’s novel, The Way West, won the 1950 Pulitzer Prize for Fiction. Gwen Florio has won several journalism awards and has been nominated for a Pulitzer Prize three times. Other notable Montana authors include Thomas McGuane, Ivan Doig, James Welch, Dorothy Johnson and Craig Lancaster. MT55

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Life begins (again) at 65 By Bruce Horovitz, Kaiser Health News

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was convinced I would become an adult when I turned 21. But now, I’m certain that turning 65 was the watershed moment that finally grew me up. I’m pleased as pomegranate punch to be 65 — and alive. Not just alive and breathing, but actively engaged in making the right choices about this next chapter. “We enter this phase of life without a playbook or anything equivalent to institutions like elementary school and college that prepare youth for adulthood,” said James Firman, CEO of the National Council on Aging, who turned 65 two years ago. “There’s really nothing to prepare us for the transition to this next phase of life.” My playbook on preparing for life after 65: • Consider enrolling in Medicare Part A, to cover hospitalization expenses. It works for me because my family is still covered under my wife’s health care plan. • Double up on checkups. My annual visit to my primary care doctor evolved into a biannual visit. “Age 65 is a time to proactively visit a geriatric physician instead of just going when you’re in trouble,” said Dr. Ardeshir Hashmi, director of the Center for Geriatric Medicine at Cleveland Clinic. “Don’t wait until things get to a point where you’re in a cycle of being in and out of the hospital all the time.” Starting at age 65, he said, these visits should last longer than the standard 20 minutes — so older patients have time to discuss what’s on their minds. Older patients who do this regularly tend to require “minor tweaks” instead of major repairs, said Hashmi. • Schedule annual visits to the dermatologist, ophthalmologist — and visits every five years to the gastroenterologist. “Establishing a coordinated care team becomes more important at 65,” said Jean Setzfand, senior vice president of programs at AARP. • Take the leap and sign up for long-term health insurance. My wife and I finally did after putting it off for years. Remember, it’s a lot easier — and cheaper — to get when you’re younger than 65. • Stick to a vaccine regimen. Vaccines are important again. I’ve since received my first pneumonia vaccine. My doctor also told me to get the new shingles vaccine, Shingrix, because I developed shingles about five years ago. • Evaluate your diet. I have mostly stopped eating red meat, except for the very occasional burger. I now opt for meals mostly composed of fruit, veggies and my new diet staple that I used to gag on as a kid: salmon. • Bone up on Social Security. I attended a free countyfunded seminar at the local library. Then, to discuss my personal needs, I met (for free) with the same volunteer who led the seminar. • Challenge your financial plan. I changed financial advisers — based on recommendations from trusted friends — because my portfolio really matters now. • Serve your community. I bumped-up my volunteer schedule to once a week instead of once a month at a local food pantry. I also volunteer every other week at a local homeless shelter on the 5 p.m.-to-midnight shift. I’ve most recently started to volunteer at an equestrian therapy center for kids with mental or physical handicaps. Each of my volunteer gigs reflect my personal interests.

• Stay active. I extended my daily exercise routine from five days to seven. I now swim at least five days a week; take our dog, Shadow, for 45-minute walks twice daily; and hit the weight room at least twice weekly. I also play Wallyball (a fast-moving form of indoor volleyball where the walls are considered inbounds) every week with friends who are equally motivated to stay in shape. • Stay flexible. I learned to stretch my back muscles an extra long time before beginning any strenuous exercise. When I forget, I inevitably pay for it. • Look to the future. I initiated “adult,” end-of-life conversations with my kids that I wish my parents had had with me. • Get your paperwork in order. I not only updated my will but I filled out a “Five Wishes” end-of-life pamphlet created by the Aging With Dignity nonprofit group; and I got very specific, in writing, about where I want my ashes to be scattered. • Stay connected — and not solely to devices. I stopped taking my friends for granted, banished past grudges and re-established contact with a best buddy from college whose friendship I’d foolishly let slip away. Age 65 is when many of us realize that we’re mortal. “This is when we start thinking about our next 20 to 30 years,” said Hashmi. “It’s when we ask: How can I be smart about investing my remaining decades wisely?” Eric Tyson, author of “Personal Finance After 50 for Dummies,” theorizes that one of the most powerful undercurrents of turning 65 is how it affects the working lives of so many Americans. It’s when the majority go from working full time to working less — or not working at all, he said. “The best scenario is when this change can unfold over many years instead of all at once.” It has for me. Things started changing at age 62, when I took a buyout from USA TODAY, where I’d worked for 20-plus years as a marketing reporter. I’m now a freelance writer and media training consultant. So, at 65, the one thing I’ve opted to put off for at least a few years is retiring. While 65 still remains the most common retirement age, more and more folks are breaking that tradition, said AARP’s Setzfand. Call it living with purpose. Turning 65 is not just an extension of middle age. It’s a new life chapter that’s waiting to be written. “It’s a new stage of life that reminds us we don’t have forever,” said Firman. About a decade ago, at age 56, Firman had a quintuple bypass operation. His father, grandfather and uncle all died of heart disease in their 40s and 50s. Firman isn’t distraught over the family genes he inherited. Instead, he’s celebrating his survival. When he turned 65 two years ago, he said, he had a realization that the real purpose of aging is to make the world a better place. “Life is a gift,” he said. “Success in old age starts with an attitude of gratitude.” It seems Firman and I share one common trait: We both grew up at 65. MT55 25 mt55mag.com

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Alzheimer’s warning signs

lzheimer’s can be difficult to detect early on because the common symptoms could also be general signs of an aging brain — forgetting information or how to do a technical task, slower physical movements. Knowing what to look for can help with early diagnosis and treatment and management of the disease. The Alzheimer’s Association has 10 warning signs that could signal dementia, an umbrella term for a wide range of symptoms which Alzheimer’s falls under. 1. Memory loss that disrupts daily life, especially forgetting recently learned information. Also watch out for forgetting important events, repeatedly asking for the same information or needing to rely on memory aids. 2. Challenges in problem-solving or concentration, including difficulty following a recipe or keeping track of bills. Regular tasks may take longer to complete than normal. 3. Difficulty completing familiar tasks like driving to a regular location, managing a budget or remembering the rules of a game. 4. Confusion with time or place and forgetting where they are or how they got there. People suffering from dementia may have difficulty understanding something that is not happening right now. 5. Trouble understanding visual images or spatial relation-

ships, vision problems, difficulty reading or judging distance or distinguishing between colors. This may cause difficulty with driving. 6. Problems speaking or writing, joining the middle of a conversation or being able to keep up a conversation. They may struggle to find the right words or use the wrong name to describe something. 7. Losing or misplacing items, losing the ability to backtrack to find items they’ve misplaced or accusing people around them of stealing items they have misplaced. 8. Exercising poor judgment in decision making, such as giving large amounts of money to telemarketers or scammers or other bad financial decisions, paying less attention to their own hygiene or house cleaning. 9. Withdrawing from work or social activities, ceasing to participate in hobbies or following a favorite sports team. This could be because they have difficulty remembering how to participate or self-imposed isolation because of the changes they’ve experienced. 10. Changes in mood and personality, with ill people becoming confused, suspicious, depressed, anxious, fearful or even paranoid. They may get upset easily with friends, family or coworkers or when they are in places that are out of their comfort zone. MT55 27 mt55mag.com

Dispelling Alzheimerâ&#x20AC;&#x2122;s myths

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lzheimer’s is a fairly well known illness, but there is a lot of misinformation as to what causes it, how successful treatment can be and other facets. Because there’s a lot we don’t know, people often look for answers that research doesn’t back up. The Alzheimer’s Association shared a number of the most common myths and the actual facts behind those myths. Myth: Drinking out of aluminum cans can cause Alzheimer’s About 50 years ago, Americans looked at aluminum exposure as a possible cause of Alzheimer’s. This suspicion made people worry about pots, pans and soda cans as well as antiperspirants and certain antacids. Studies have not confirmed any of these suspicions, and scientists today are looking at other possible causes of the disease. Myth: Treatments are available that stop the progression of Alzheimer’s Sadly, there are no such treatments. Alzheimer’s destroys the brain cells and is always fatal, and scientists have not yet found a way to even slow the disease long-term. The FDA has approved drugs that seem to temporarily slow the symptoms for a few months for about half the individuals who need them.

Myth: Aspartame causes memory loss Aspartame is an artificial sweetener used in a number of products and sold on its own under brand names like Nutrasweet and Equal. The Food and Drug Administration approved its use in 1996, since that time, a number of concerns have been raised about its safety for human consumption. However, there is no scientific evidence backing up concerns that aspartame use is related to memory loss or other symptoms of dementia. Myth: Silver dental fillings increase the risk of Alzheimer’s The concern about this arose because silver fillings are less than half silver; they are mostly mercury, which is a heavy metal that can be toxic in certain forms. However, the FDA, the World Health Organization and other public health organizations say there is no relationship between silver amalgam fillings and Alzheimer’s. Myth: Vaccines increase the risk of Alzheimer’s This idea, put forward by a now-discredited doctor, has been shown to be false. On the contrary, a number of studies show regular vaccinations, including tetanus, diphtheria, polio and even an annual flu shot not only contribute to a reduced risk of Alzheimer’s but contribute to greater overall health. MT55

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Support Circle:

Caregivers share tips to ease Alzheimer’s toll By Blake Farmer, Nashville Public Radio

icki Bartholomew started a support group for wives who are caring for a husband with Alzheimer’s disease because she needed that sort of group herself. They meet every month in a conference room at a new memory-care facility in Nashville called Abe’s Garden, where Bartholomew’s husband was one of the first residents — a Vietnam veteran and prominent attorney in Nashville. “My husband’s still living, and now I’m in an even more difficult situation — I’m married, but I’m a widow,” she tells the group one day. These women — who are roughly 50 to 75 years old — draw the shades and open up to each other in ways they can’t with their lifelong friends. “They’re still wonderful friends, but they didn’t know how to handle this. It was hard for them, and as you all know, 30

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your friends don’t come around as much as they used to,” Bartholomew said. “I was in bad shape. I didn’t think I was — I did have health problems, and [now] I know I was depressed.” As the number of Americans afflicted with Alzheimer’s disease continues to swell to an estimated 5.7 million, so do the legions of loved ones caring for friends and family members. The toll on Bartholomew’s own mental health is one of the reasons the Alzheimer’s Foundation of America focuses on the nation’s estimated 16 million unpaid caregivers. With no cure on the horizon, the foundation has been highlighting the necessity of better support for those caregivers through a national tour. It stopped in Nashville earlier this spring, was in Milwaukee in June and went to Fairfax, Va., in September.

At the live events, Alzheimer’s researchers and clinicians offer guidance on a number of topics, including how to ensure safety for patients at home, care planning and even how to entertain someone with memory loss. The organization promotes in-person and telephone support groups, since being a caregiver is often a barrier to getting out of the house alone. Virtual support systems showed effectiveness at reducing loneliness, stress and depression in a small 2014 study. “We have to do everything we can to educate a caregiver, to provide them with the best practices on caring for somebody,” said Charles Fuschillo Jr., the AFA’s CEO. For example, the AFA recommends that family members: Feed Alzheimer’s patients one food at a time. “A busy plate can be confusing,” the group says. Mark rooms in the house with signs to avoid unnecessary confusion. Remind a person with Alzheimer’s to use the toilet; don’t wait for them to ask. When traveling, stick with familiar destinations. Watch for a cough while eating; it can signal a swallowing disorder in people with dementia. Schedule overnight stays at a memory-care facility so the caregiver gets some respite. Just as important, Fuschillo said, “we want to do everything we can to avoid caregiver burnout.” The breaking point sneaks up on even the most committed caregiver, say Alzheimer’s advocates, especially as the nights grow more sleepless. Alzheimer’s patients can tend to pace, or wake up their partner every few minutes. They can become violent. Or, perhaps worse, they can leave the house. “And I’ve had some issues at night that I had to take care of alone,” Pam Hawkins, who cares for her husband with Alzheimer’s, said during a support session. “But I’m not ready to have anyone there at night.” For now, she said, her husband usually sleeps all night. And if there’s a problem, her son-in-law is 15 minutes away. She’s had to hire caregivers during the day. Knowing how to find and hire the right person is a shared concern by Alzheimer’s family members that inspired a checklist for navigating the process. Tips include these: Interview the aide in the home. Over-share information about the patient. Ask what kind of quality control a supervisor would provide. Hawkins is adamant about keeping her husband at home, whatever the cost. “He’s not going anywhere,” she said. “He’s staying at our home until he moves to heaven. We made that decision a long time ago.” But many caregivers have no choice. April Simpkins said tending to her husband became allconsuming, and she’s young enough that she still needs to keep her job; she works at a local university. “It was not possible for us to keep Joe at home,” she said. Simpkins found she’d often have to call her husband’s siblings to settle him down over the phone. One night, she had to dial 911 when he kept yelling in the hallways of their condo building. And yet she felt some societal pressure that she wasn’t doing enough. “There’s a lot of … glory given to the whole idea of some-

one being long-suffering and staying at home and giving up their life, basically, to care for their loved one,” Simpkins said. “It makes it harder for people who can’t do that.” Everyone around the table nodded in agreement. Whatever stage of illness their loved one is experiencing, these caregivers understand the complicated existence that many have dubbed “the long goodbye.” Along with sharing the sorrow, they find a way to share in the humor of it all — one woman said her husband wears a laundry-basket’s-worth of shirts and pants because he forgets he’s already gotten dressed. Even tips on how to reduce the odor from incontinence are offered with a loving laugh. The support group ends with hugs. Some women head for the parking lot. Others buzz through the locked doors to see their husbands. Simpkins, 54, sits down for lunch with Joe, who is a former state employee and a youthful-looking 66 years old. She drapes an arm around his slumping shoulders and assists him as he spears a cold strawberry with his fork. “You know, there are some days,” she said, interrupted by a random reflection from Joe. “Yeah, some days are clearer than others.” Simpkins tries to stop by to see her husband every day. But it’s a wicked kind of blessing, she said, that when she misses a visit, Joe no longer notices. MT55 This story is part of a partnership that includes Nashville Public Radio, NPR and Kaiser Health News.

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